2022 Volume 71 Issue 3 Pages 560-566
We present a case of infective endocarditis (IE) diagnosed through the detection of Granulicatella adiacens in a blood culture that turned positive at night. A man in his 50s had a fever of over 37°C, which did not surpass 39°C, and malaise for a few days. He was transferred to our hospital on experiencing impaired consciousness and dysarthria. Brain magnetic resonance imaging, performed on suspicion of a lesion, revealed an infarct centered in the left occipital lobe. After collecting various specimens, tazobactam/piperacillin was administered but changed to ampicillin because gram-positive streptococci were detected. Initially, a streptococcal infection was suggested. However, on subculturing, as no growth was observed on 5% sheep blood agar, nutritionally variant streptococci (NVS) were suspected, and chocolate agar and brucella HK agar were used. Anaerobic subculturing revealed colonies showing alpha-hemolysis. Owing to strong NVS suspicion, an additional gentamicin dose was administered. Transesophageal echocardiography was performed to detect the infarction source, which indicated IE; thus, the diagnosis cardiogenic cerebral embolism was made. The organism identified as G. adiacens was also detected in his warts. Thus, the patient’s condition was diagnosed as endocarditis caused by G. adiacens. Since IE treatment is of a long duration, identifying the causative agent is crucial, and selecting an appropriate isolation medium is important because NVS such as G. adiacens do not grow in a normal medium.
